| NPI | 1427381219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 0134401) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NM 0134401) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2010-09-01 |